Use of radioguided surgery technique for the treatment of thyroid cancer recurrence: clinical, surgical and anatomopathological aspects

Introduction: Surgery is the treatment of choice in locoregional thyroid neoplasia recurrence. The intense tissue healing process observed after surgery changes the neck anatomy, makes reoperation difficult, and interferes with surgical success. The use of the Radioguided Occult Lesion Localization (ROLL) technique has become a viable option to localize thyroid tumors. Objective: To analyze the use of the ROLL technique for the treatment of thyroid cancer recurrence with respect to its clinical, surgical and anatomopathological aspects. Methods: A descriptive cross-sectional study that analyzed 56 medical records and anatomopathological examinations of patients of both sexes who had thyroid neoplasms, underwent previous surgeries on this topography, and were submitted to the ROLL technique for recurrence removal from March 2011 to March 2019. Results: Most patients were women aged 46.05 years, on average. Papillary thyroid neoplasm was the most prevalent histological finding. In 100% of the cases, application of the ROLL technique identified and removed the lesions marked with suspicion for malignancy. Conclusion: Radioguided surgery has proved to be a very effective and safe tool to assist with lesion localization for the treatment of thyroid cancer recurrence. This technique has brought no additional side effects to patients, required minimal radiation and made surgery less invasive, reducing postoperative complication rates.

Gestação e deficiência de vitamina D: artigo de revisão na literatura / Pregnancy and vitamin D deficiency: literature review article

Racional: A vitamina D é um hormônio que age no metabolismo do cálcio e do fósforo. Seus receptores podem ser encontrados em quase todos os tecidos do organismo. Na gestação, a deficiência de vitamina D pode ser um fator de risco para eventos negativos para a gestante e para o recémnascido. Métodos Scielo, Bireme, Pubmed e a partir das fontes Medline e Lilacs. As palavras-chave utilizadas nas buscas foram "gestação", "deficiência" e "vitamina D". Um total de 26 trabalhos foram analisados. Resultados: A deficiência de vitamina D na gestante não é incomum. Uma dieta insuficiente em cálcio e vitamina D durante a gestação pode desenvolver complicacões materno-fetais e infantis. Maior risco de pré­eclampsia, resistência insulínica, diabetes gestacional, vaginose bacteriana e aumento da possibilidade de parto cesáreo pode ser identificado em gestantes com essa deficiência, assim como maior incidência de parto pré-termo, baixo peso do recém-nascido e restrição do crescimento intrauterino, além de aumentar o risco de desenvolvimento de diabetes tipo 1, asma e rinite na criança. Conclusões: A prevenção, o diagnóstico precoce e o tratamento da deficiência de vitamina D em gestantes é de fundamental importância para minimizar os riscos de eventos adversos materno-fetais e infantis.

Background: Vitamin D is an hormone that acts on calcium and phosphorus metabolism. Their receptors can be found in almost all tissues of the body. During pregnancy, vitamin D deficiency may be a risk factor for adverse events for the mother and the newborn. Methods: An review of the literature between the months of February and August 2015. We consulted books, journals and selected journal articles through search in databases Scielo, Bireme, Pubmed and from Medline and Lilacs sources. The keywords used in the search were "pregnancy", "deficiency" and "vitamin D". A total of 26 papers were analyzed. Results: Vitamin D deficiency during pregnancy is not uncommon. Insufficient dietary calcium and vitamin D during pregnancy may develop maternal and fetal and infant complications. Increased risk of pre-eclampsia, insulin resistance, gestational diabetes, bacterial vaginosis and increased chance of cesarean section can be identified in women with this deficiency, as well as higher incidence of preterm birth, low birth weight of the newborn and intrauterine growth restriction, in addition to increasing the risk of developing type 1 diabetes, asthma and rhinitis in children. Conclusions: Prevention, early diagnosis and treatment of vitamin D deficiency in pregnants is extremely important to minimize the risk of maternal and fetal and infant adverse events.

Hemorragia subaracnóidea aneurismática: análise da evolução dos pacientes internados em um hospital de Tubarão / Aneurysmal subarachnoid hemorrhage: analysis of the evolution of the patients hospitalized at a hospital of Tubarão

Introdução: Estima-se que 2 a 3% dos seres humanos sejam portadores de aneurismas intracranianos. A ruptura dessas lesões gera um quadro clínico grave, com hemorragia subaracnóidea, cuja taxa de mortalidade chega a 40%. Objetivo: Analisar a evolução dos pacientes com hemorragia subaracnóidea de origem aneurismática internados no Hospital Nossa Senhora da Conceição (HNSC). Métodos: Realizado um estudo de coorte histórica e coorte. A população foi composta por todos os pacientes portadores de hemorragia subaracnóidea aneurismática internados entre janeiro de 2005 e maio de 2007. Resultados: A população foi composta por 33 pacientes, com prevalência maior em mulheres (57.5%). Pacientes tabagistas totalizaram 63% e hipertensos 54.6%. História prévia de aneurismas foi duas vezes maior no grupo de mau prognóstico (RP=2.00; IC 95%: 1.32-2.92). Cefaléia ou meningismo foi a apresentação clínica mais comum (66.7%). Pacientes submetidos ao tratamento cirúrgico apresentaram uma prevalência quase 60% menor de vir a ter um desfecho ruim na alta hospitalar (RP=0.43; IC 95%: 0.26-0.70; pKruskal-Wallis =0.03). Após a hemorragia aguda, 42.3% dos integrantes puderam retomar suas atividades laborais. Conclusão: Os resultados encontrados foram compatíveis com os descritos na literatura, o que sustenta a manutenção da modalidade terapêutica atual do HNSC frente aos pacientes com hemorragia subaracnóidea aneurismática.

Introduction: It is estimated that 2 to 3% of humans have intracranial aneurysms. The rupture of this lesion develop a serious clinical situation, with subarachnoid hemorrhage, whose rate of mortality arrives to 40%. Objective: To analyze the evolution of the patients with subarachnoid hemorrhage originated from intracranial aneurysms hospitalized at Nossa Senhora da Conceição Hospital (HNSC). Methods: A study of historical cohort and cohort. The population was formed by aneurysmal subarachnoid hemorrhage diagnosis patients hospitalized from January 2005 though May of 2007. Results: The population was formed by 33, with a higher prevalence in women (57.5%). Patients who were smokers summed 63%, and those with hypertension 54.6%. Previous history of aneurism was two times higher in the group of bad prognosis (PR=2.00; CI 95%: 1.32-2.92). Headache or meningism was the most common clinical presentation (66.7%). Patients submitted to surgical treatment presented a prevalence almost 60% lower of coming to have a bad prognosis in the discharge (PR=0.43; CI 95%: 0.26-0.70; pKruskal-Wallis =0.03). After the sharp hemorrhage, 42.3% of the participants were able to return to their labor activities. Conclusions: The results found here were compatible with the literature, ones what sustains the maintenance of the current therapeutic modality of the HNSC front to the patients with aneurysmal subarachnoid hemorrhage.

Achados principais de exames laboratoriais no diagnóstico de apendicite aguda: uma avaliação prospectiva / Main findings in laboratory tests diagnosis of acute appendicitis: a prospective evaluation

RACIONAL: Apendicite aguda é a doença abdominal cirúrgica mais comum nas unidades de emergência. Embora o diagnóstico seja clínico, a realização de exames complementares pode ser útil na dúvida diagnóstica. OBJETIVO: Avaliar as principais alterações de exames laboratoriais em pacientes com apendicite aguda, assim como sua relação com a fase evolutiva da doença. MÉTODOS: Avaliação prospectiva de pacientes com diagnóstico de apendicite aguda submetidos ao tratamento cirúrgico. RESULTADOS: Cento e setenta e nove pacientes participaram deste estudo, a maioria do sexo masculino. A idade média foi de 26 anos. Em relação à contagem de leucócitos, 46,9% apresentavam valores <15.000 mm3. A porcentagem média dos polimorfonucleares foi de 81,7%, de bastões 1,2%, de eosinófilos 1%, de linfócitos 12,8% e de monócitos 2,9%. A proteína C reativa foi solicitada para 54 pacientes. Ela foi <10 mg/dl em 19, entre 10 e 50 mg/dl em 24 e maior ou igual a 50 mg/dl em 11. Com relação à fase evolutiva 64% pacientes apresentaram estágio inicial (fases 1 e 2), 16,2% fase 3 e 35 fase 4. 57% dos pacientes com contagem de leucócitos totais maior ou igual a 20.000/mm3 apresentaram perfuração apendicular (p<0,05). A porcentagem de leucócitos polimorfonucleados de pacientes com fases iniciais foi menor em relação às avançadas (79,8% e 85,1%, respectivamente), com valor de p<0,05. Pacientes com fases avançadas de apendicite aguda a quantidade de linfócitos foi menor em relação às iniciais (9,3% e 14,8%, respectivamente), com valor de p<0,05. Noventa e quatro porcento dos pacientes com valores de proteína C reativa <10 mg/dl apresentaram fases iniciais de inflamação apendicular (p<0,05). CONCLUSÃO: Houve associações significativas entre contagem total e diferencial de leucócitos, valores de proteína C reativa e fase evolutiva de inflamação apendicular.

BACKGROUND: Acute appendicitis is the most common surgical abdominal disease in the emergency room. Although the diagnosis is clinical the complementary tests may be useful in doubt. AIM: To evaluate the main laboratory tests in patients with acute appendicitis, as well as its relationship with the evolutionary stage of the disease. METHODS: Prospective evaluation of patients with acute appendicitis who underwent surgical treatment. RESULTS: A total of 179 patients participated in this study, most were male. The mean age was 26 years. For leukocyte count 46.9% had values ​​<15.000mm3. The mean percentage of polymorphonuclear cells was 81,7%, 1,2% of sticks, 1% eosinophils, lymphocytes 12,8% and 2,9% monocytes. C-reactive protein was required for 54 patients. It was <10 mg/dl in 19, between 10 and 50 mg/dl in 24 and greater than or equal to 50 mg/dl in 11. Regarding the evolutionary phase 64% patients had early stage (stages 1 and 2), 16,2% stage 3 and 35 stage 4. A total of 57% of patients with white blood cell count greater than or equal to 20.000/mm3 had appendicular perforation (p<0,05). The percentage of polymorphonuclear leukocytes from patients with early stages was lower than the later stages (79,8% and 85,1%, respectively), with p<0,05. Patients with advanced stages of acute appendicitis, the number of lymphocytes was lower than the initial stages (9,3% and 14,8%, respectively), with p<0,05. 94% of patients with C-reactive protein values ​​<10 mg/dl showed early stages of appendicular inflammation (p<0,05). CONCLUSION: A significant association among total and differential leukocyte count, C-reactive protein values ​​and evolutionary phase of appendiceal inflammation was found in this prospective analysis.

Main findings in laboratory tests diagnosis of acute appendicitis: a prospective evaluation.

BACKGROUND: Acute appendicitis is the most common surgical abdominal disease in the emergency room. Although the diagnosis is clinical the complementary tests may be useful in doubt. AIM: To evaluate the main laboratory tests in patients with acute appendicitis, as well as its relationship with the evolutionary stage of the disease. METHODS: Prospective evaluation of patients with acute appendicitis who underwent surgical treatment. RESULTS: A total of 179 patients participated in this study, most were male. The mean age was 26 years. For leukocyte count 46.9% had values ​​<15.000mm3. The mean percentage of polymorphonuclear cells was 81,7%, 1,2% of sticks, 1% eosinophils, lymphocytes 12,8% and 2,9% monocytes. C-reactive protein was required for 54 patients. It was <10 mg/dl in 19, between 10 and 50 mg/dl in 24 and greater than or equal to 50 mg/dl in 11. Regarding the evolutionary phase 64% patients had early stage (stages 1 and 2), 16,2% stage 3 and 35 stage 4. A total of 57% of patients with white blood cell count greater than or equal to 20.000/mm3 had appendicular perforation (p<0,05). The percentage of polymorphonuclear leukocytes from patients with early stages was lower than the later stages (79,8% and 85,1%, respectively), with p<0,05. Patients with advanced stages of acute appendicitis, the number of lymphocytes was lower than the initial stages (9,3% and 14,8%, respectively), with p<0,05. 94% of patients with C-reactive protein values ​​<10 mg/dl showed early stages of appendicular inflammation (p<0,05). CONCLUSION: A significant association among total and differential leukocyte count, C-reactive protein values ​​and evolutionary phase of appendiceal inflammation was found in this prospective analysis.

Importância da Associação Tubaronense de Diabete Infanto-juvenil no perfil dos pacientes com Diabete Melito Tipo 1 / Role of tubaronense association of juvenile diabetes on patient's profile with diabetes mellitus type 1

Introdução: Existem associações que têm como objetivo promover a educação para os portadores de diabete e seus familiares, buscando ajudá-los a lidar com as dificuldades encontradas nessa enfermidade. Objetivo: Esse estudo teve por objetivo conhecer a importância da Associação Tubaronense de Diabete Infanto-Juvenil no perfil de uma amostra dos pacientes com diabete melito tipo 1. Métodos: Foi realizado um estudo observacional. A população foi composta por pacientes com diagnósticode diabete tipo 1 na região de Tubarão, com faixa etária de 0 a 19 anos, dividida em dois grupos. O primeiro, (10indivíduos) formado por participantes da Associação de Diabete Infanto-Juvenil. O segundo, (10 indivíduos) por pacientes com diabete tipo 1 não pertencentes à associação de diabete.Resultados: O grupo participante da associação tinha como principal esquema insulínico (60 %) o uso deinsulina Lenta e Ultra-rápida conforme necessidade, enquanto o principal regime insulínico no outro grupo erainsulina NPH e Regular fixa. O grupo associação recebia maior auxílio governamental para o tratamento dadoença. Com isso, o grupo que fazia parte da associação apresentou média (média=7,7; DP=1,16) de hemoglobinaglicada inferior à média do grupo não-associação (média=9,5; DP=0,70). A freqüência de internação por cetoacidose no grupo não-associação foi maior que no grupo associação (RR=7,0; IC 95%: 1,14 - 42,97; pFisher=0,003). Conclusão: Fazer parte da Associação de Diabete Infanto-Juvenil fez com que os participantes com diabete tipo 1 apresentassem menor número de complicaçõesagudas, melhor manejo da doença, com valores de hemoglobina glicosilada possivelmente menores.

Introduction: There are organizations that have as an objective the promotion of education for diabetics and their families, aiming to help them deal with the difficulties found in this disease.Objective: This study had as an objective the understanding of the importance of Tubaronense´s Infantileand Juvenile Diabetic Association in a profile of a sample of type 1 diabetic patients. Methods: An observational study was realized. The population was formed by of patients with diabetes type1 diagnosis in the region of Tubarão, with and age ranging from 0 to 19 years old, divided into two groups. Thefirst, (10 individuals) formed by of participants of Tubaronense´s Infantile and Juvenile Diabetic Association.The second group, (10 individuals) by patients with type 1 diabetes not enrolled in the diabetic association.Results: The participant group of association had asthe main insulin therapy (60%) the use of Lente and Ultra-rapid insulin used as needed while the main insulin therapy used in the non participant group was the NPHand Regular insulin (fixed dosing). The participant group received more governmental help for the treatment ofthe disease. Therefore, the group that participated in the association presented and average (average=7.7; SD=1.16) of glycated hemoglobine lower then the average found in the group of non participants (average=9.5; SD=0.70). The hospitalization frequency because of diabetic ketoacidosis in the non association group was higher then in the association group (RR=7.0; CI 95%:1.14 – 42.97; pFisher=0.003).Conclusion: The participation in the Tubaronense´s Infantile and Juvenile Diabetic Association provided thediabetic type 1 patients with a smaller number of acute complications, better management of the disease, withvalues of glycosylated hemoglobine probably lower.